Minimal important change and minimum clinically important difference values of the KOOS-12 after total knee arthroplasty

Eckhard, Lukas; Munir, Selin; Wood, Donna J.; Talbot, Simon; Brighton, Roger; Walter, William K.; Baré, Jonathan

doi:10.1016/j.knee.2021.03.005

Cited by 29 publications

(25 citation statements)

References 10 publications

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“…The KOOS difference in symptoms may be due to the difference in follow-up time between the KOOS scores, with the MAKOs being collected later for the KOOS questionnaire (14 vs 20 months, p<0.001), and TKA symptoms having been shown to improve over time [31,32]. It should also be noted that none of the differences came close to the minimal clinical important difference (MCID) for KOOS or OKS scores indicating that there was no clinically significant difference in short-term outcomes between the groups [38,39], and excellent scores in both. Studies analysing longer-term data may tease out if there is a functional difference between these two robotic systems.…”

Section: Discussionmentioning

confidence: 97%

How does the use of quantified gap-balancing affect component positioning and limb alignment in robotic total knee arthroplasty using functional alignment philosophy? A comparison of two robotic platforms

Murphy

Shatrov

Duong

et al. 2023

International Orthopaedics (SICOT)

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Purpose This study aimed to compare the effect of an image-based (MAKO) system using a gap-balancing technique with an imageless (OMNIbot) robotic tool utilising a femur-first measured resection technique. Methods A retrospective cohort study was performed on patients undergoing primary TKA with a functional alignment philosophy performed by a single surgeon using either the MAKO or OMNIbot robotic systems. In all cases, the surgeon’s goal was to create a balanced knee and correct sagittal deformity (eliminate any fixed flexion deformity). Intra-operative data and patient-reported outcomes (PROMS) were compared. Results A total of 207 MAKO TKA and 298 OMNIbot TKAs were analysed. MAKO TKA patients were younger (67 vs 69, p=0.002) than OMNIbot patients. There were no other demographic or pre-operative alignment differences. Regarding implant positioning, in MAKO TKAs the femoral component was more externally rotated in relation to the posterior condylar axis (2.3° vs 0.1°, p<0.001), had less valgus femoral cuts (1.6° vs 2.7° valgus, p<0.001) and more varus tibial cuts (2.4° vs 1.9° varus, p<0.001), and had more bone resected compared to OMNIbot TKAs. OMNIbot cases were more likely to require tibial re-cuts than MAKO (15% vs 2%, p<0.001). There were no differences in femur recut rates, soft tissue releases, or rate of achieving target coronal and sagittal leg alignment between robotic systems. A subgroup analysis of 100 MAKO and 100 OMNIbot propensity-matched TKAs with 12-month follow-up showed no significant difference in OKS (42 vs 43, p=0.7) or OKS PASS scores (83% vs 91%, p=0.1). MAKO TKAs reported significantly better symptoms according to their KOOS symptoms score than patients that had OMNIbot TKAs (87 vs 82, p=0.02) with a higher proportion of KOOS PASS rates, at a slightly longer follow-up time (20 months vs 14 months, p<0.001). There were no other differences in PROMS. Conclusion A gap-balanced technique with an image-based robotic system (MAKO) results in different implant positioning and bone resection and reduces tibial recuts compared to a femur-first measured resection technique with an imageless robotic system (OMNIbot). Both systems achieve equal coronal and sagittal deformity correction and good patient outcomes at short-term follow-ups irrespective of these differences.

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Section: Discussionmentioning

confidence: 97%

How does the use of quantified gap-balancing affect component positioning and limb alignment in robotic total knee arthroplasty using functional alignment philosophy? A comparison of two robotic platforms

Murphy

Shatrov

Duong

et al. 2023

International Orthopaedics (SICOT)

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“…However, there was no significant difference between the groups in KOOS scores 3 months post-operation (long-term) in all domains. Eckhard et al [ 14 ] reported that the minimal clinically important difference values for pain, function-daily living, and quality of life are 12.5, 15.2, and 8, respectively, in the KOOS-12 questionnaire.…”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of subcutaneous continuous local infiltration analgesia with ropivacaine in patients undergoing total knee arthroplasty: a comparative study

AlSaati

Alaqaili

Alshammari

et al. 2023

BMC Musculoskelet Disord

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Background Continuous local infiltration analgesia (CLIA) can be administered via intraarticular or periarticular techniques in patients undergoing total knee arthroplasty (TKA). The purpose of this investigation was to retrospectively report a single-center experience of epidural analgesia with subcutaneous CLIA versus epidural analgesia without CLIA among patients undergoing TKA. Methods This single-center retrospective study was conducted in Saudi Arabia. From January 01, 2014, to December 30, 2020, medical records of all patients who underwent TKA were reviewed. Patients who received subcutaneous CLIA with epidural analgesia were assigned to the intervention group, whereas those who received epidural analgesia without subcutaneous CLIA were assigned to the control group. The efficacy endpoints included: (i) postoperative pain scores at 24 h, 48 h, 72 h, and 3 months; (ii) postoperative opioid consumption at 24 h, 48 h, 72 h, and 24–72 h (cumulative); (iii) length of hospital stay; and (iv) postoperative functional recovery of the knee 3 months post-operation, according to the Knee Injury and Osteoarthritis Outcome Score. Results At rest and during mobilization, the CLIA group (n = 28) achieved significantly lower postoperative pain scores 24 h, 48 h, 72 h, and 3 months post-operation than the non-CLIA group (n = 35). Subgroup analysis revealed that the CLIA group achieved significantly less opioid consumption 24 h and 48 h post-operation than the non-CLIA group. There was no difference between the groups regarding the length of hospital stay or functional scores 3 months post-operation. There was no significant difference between the groups regarding the rate of wound infection, other infections, and readmission within 30 days. Conclusion Subcutaneous CLIA is a technically feasible and safe procedure without major adverse events but with reduced postoperative pain scores (at rest and during mobilization) and opioid consumption. Additional larger studies are warranted to confirm our results. Moreover, a head-to-head comparison between subcutaneous CLIA and periarticular or intraarticular CLIA is an interesting prospective investigation.

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“…It is not recommended that MCIC estimates be used to assess individual-level change 26 , although we recognize that anecdotally they are commonly used in this way. We are not aware of published MCIC estimates for the HOOS-12, although 1 smaller study reported estimates for the KOOS-12 7 . While the choice of anchor was similar between that study and ours, there were differences in score distributions that make MCIC comparisons challenging.…”

Section: Discussionmentioning

confidence: 99%

“…Recent psychometric evaluations indicate that the HOOS-12 and KOOS-12 are valid and highly responsive to change 5,6 . We are aware of only 1 previous study examining clinically important improvements in KOOS-12 scores, and that study was restricted to patients receiving 1 type of knee replacement prosthesis 7 .…”

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confidence: 99%

Minimal Clinically Important Changes in HOOS-12 and KOOS-12 Scores Following Joint Replacement

Soh

Harris

Cashman

et al. 2022

Journal of Bone and Joint Surgery

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Background:For patient-reported outcome measures (PROMs) to provide meaningful information to support clinical care, we need to understand the magnitude of change that matters to patients. The aim of this study was to estimate minimal clinically important changes (MCICs) for the 12-item Hip disability and Osteoarthritis Outcome Score (HOOS-12) and Knee injury and Osteoarthritis Outcome Score (KOOS-12) among people undergoing joint replacement for osteoarthritis.Methods:Individual-level data from the Australian Orthopaedic Association National Joint Replacement Registry’s pilot PROMs program were used for this analysis. Preoperative and 6-month postoperative HOOS-12 and KOOS-12 domain and summary impact scores plus a rating of patient-perceived change after surgery (on a 5-point scale ranging from “much worse” to “much better”) were available. Three anchor-based approaches—mean change, receiver operating characteristics (ROC) based on Youden’s J statistic, and predictive modeling using a binary logistic regression model—were used to calculate MCICs based on patient-perceived change.Results:Data were available for 1,490 patients treated with total hip replacement (THR) (mean age, 66 years; 54% female) and 1,931 patients treated with total knee replacement (TKR) (mean age, 66 years; 55% female). Using the mean change method, the MCIC ranged from 24.0 to 27.5 points for the HOOS-12 and 17.5 to 21.8 points for the KOOS-12. The ROC analyses generated comparable MCIC values (28.1 for HOOS-12 and a range of 15.6 to 21.9 for KOOS-12) with high sensitivity and specificity. Lower estimates were derived from predictive modeling following adjustment for the proportion of improved patients (range, 15.7 to 19.2 for HOOS-12 and 14.2 to 16.5 for KOOS-12).Conclusions:We report MCIC values for the HOOS-12 and KOOS-12 instruments that we derived using 3 different methods. As estimates obtained using predictive modeling can be adjusted for the proportion of improved patients, these may be the most clinically applicable. These MCIC values can be used to interpret important changes in pain, function, and quality of life from the patient’s perspective.Levels of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Minimal important change and minimum clinically important difference values of the KOOS-12 after total knee arthroplasty

Cited by 29 publications

References 10 publications

How does the use of quantified gap-balancing affect component positioning and limb alignment in robotic total knee arthroplasty using functional alignment philosophy? A comparison of two robotic platforms

How does the use of quantified gap-balancing affect component positioning and limb alignment in robotic total knee arthroplasty using functional alignment philosophy? A comparison of two robotic platforms

The efficacy and safety of subcutaneous continuous local infiltration analgesia with ropivacaine in patients undergoing total knee arthroplasty: a comparative study

Minimal Clinically Important Changes in HOOS-12 and KOOS-12 Scores Following Joint Replacement

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